About the role: As the Insurance Specialist you play a pivotal role as your expertise directly contributes to the success of our busy plastic surgery practice and ensures a positive financial experience for our patients.…
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Full-time
high school, associate degree, bachelor degree
Competitive Compensation, Benefits
Posted 46d ago
~40 hrs/week
Responsibilities
The Insurance Specialist manages eligibility verification, pre-authorizations, and claim submissions for a plastic surgery and weight loss practice. They act as a liaison between patients, clinical staff, and insurance carriers to ensure accurate reimbursement and financial clarity.
Requirements
Requires a high school diploma and at least three years of experience as an insurance specialist, preferably within a surgical specialty. Proficiency in EHR systems, clearinghouses like TriZetto or Availity, and knowledge of HIPAA and medical coding is essential.
Full job description
About the role:
As the Insurance Specialist you play a pivotal role as your expertise directly contributes to the success of our busy plastic surgery practice and ensures a positive financial experience for our patients.Your responsibilities include checking eligibility for our weight loss patients, obtaining authorizations for surgery and office visits, and sending claim forms through our clearinghouse. You are a proactive problem-solver and a key liaison between patients, our clinical team, and insurance carriers. Your day is dynamic: from meticulously understanding eligibility, securing pre-authorizations, to expertly navigating the complexities of claim submissions.
What you'll do:
Verify eligibility for services for our weight loss clinic patients.
Ensure a smooth patient experience by meticulously verifying and submitting the pre-authorization requirements.
Champion accurate and timely reimbursement by expertly preparing and submitting medical claims for specialized plastic surgery procedures and our weight loss clinic visits.
Ensure all claims have been submitted and accepted by the clearinghouse.
Serve as back up and partner to our accounts receivable and billing specialist.
Empower patients by working alongside our Patient Care Insurance and Surgery Coordinator to clarify insurance coverage, financial responsibilities, and payment options.
Stay at the forefront of your field by maintaining up-to-date knowledge of CPT, ICD-10, and HCPCS coding guidelines specific to plastic surgery.
Navigate the evolving healthcare landscape by staying informed about changes in insurance regulations and payer policies, especially the No Surprises Act.
Contribute to continuous improvement by generating and analyzing eligibility and claims reports to identify trends, resolve issues, and uncover opportunities for enhancement.
Foster accuracy and compliance by collaborating with our clinical staff to ensure documentation robustly supports all billing.
Uphold the highest ethical standards by maintaining strict confidentiality of all patient information.
Deliver service excellence daily, meeting and exceeding the expectations of both our team members and our valued patients.
Shape our operational success by contributing to and adhering to best practices in office and insurance administration.
Embrace growth and teamwork by supporting organizational changes with a positive outlook, all while championing our core practice values of excellence, service, and respect.
Be an integral team player by performing other administrative duties as assigned to support the overall success of the practice.
Qualifications:
High school diploma or equivalent is required. Associate's degree in medical billing, healthcare administration, or a related field preferred.
Minimum of three years of experience as an insurance specialist with a demonstrated understanding of the in and out of network insurance eligibility and claim submission processes. A bachelor’s degree may substitute for some experience.
At least 1 year in a plastic surgery, dermatology, or similar surgical specialty practice is highly preferred.
Proficiency with practice management software, electronic health records (EHR) systems, TriZetto and Availity or similar insurance clearinghouses . Experience using NexTech is preferred.
Excellent written and verbal communication skills and strong attention to detail and accuracy are required.
Strong problem-solving and analytical abilities are essential.
Proficiency in Microsoft Office Suite (Word, Excel, Outlook) is required.
Knowledge of HIPAA regulations is required.
Why choose us?
Be part of a renowned aesthetic surgery practice.
Work alongside a team of dedicated professionals.
Enjoy competitive compensation and benefits.
Grow your career in a supportive environment.
Related keywords
Insurance SpecialistPlastic SurgeryWeight Loss ClinicMedical BillingClaim FormsClearinghouseNo Surprises ActCPTICD-10HCPCSHIPAANexTechTriZettoAvailityEHRHealthcare Administration
We enhance lives via personalized aesthetic & surgical care, delivering exceptional results with compassion & expertise!
Industry
Medical Practices
Company size
11-50 employees
Founded
2007
Headquarters
Richmond, VA
LinkedIn followers
380
Dr. Neil J. Zemmel, MD, FACS, is a Board Certified Plastic, Cosmetic, and Reconstructive Surgeon who is dedicated to providing his patients with the highest standards of care. At Richmond Aesthetic Surgery, we offer a comprehensive range of treatment options for body contouring, breast enhancement, facial rejuvenation, skin care, and reconstructive surgery. Our thorough and honest approach ensures that you receive the best.
Offices: 11934 W Broad St #200, Richmond, VA 23233, US
We enhance lives via personalized aesthetic & surgical care, delivering exceptional results with compassion & expertise!
Industry
Medical Practices
Company size
11-50 employees
Founded
2007
Headquarters
Richmond, VA
LinkedIn followers
380
Dr. Neil J. Zemmel, MD, FACS, is a Board Certified Plastic, Cosmetic, and Reconstructive Surgeon who is dedicated to providing his patients with the highest standards of care. At Richmond Aesthetic Surgery, we offer a comprehensive range of treatment options for body contouring, breast enhancement, facial rejuvenation, skin care, and reconstructive surgery. Our thorough and honest approach ensures that you receive the best.
Offices: 11934 W Broad St #200, Richmond, VA 23233, US